Way must be found to fund healthcare as ‘fairly and painlessly’ as possible

MacGill school hears much work to be done before universal health insurance rolled out

The current health system is full of “galloping inefficiencies and galloping waste” but a new system must be found for taking money from people as painlessly as possible and as fairly as possible, the MacGill summer school has heard.

Anthony Staines, professor of health systems at Dublin City University, said it costs €4,000 a year for every "man, woman, child and babe in arms" in the State to pay for the system as it is structured.

He was giving a briefing on the Government’s plan to introduce a system of universal health insurance by 2016.

He said there was a serious job to do to design the new universal health insurance system and that he and his colleagues were not all agreed on how that system would operate.


“We are not trying to sell any particular solution,” he said. “We really have to think carefully and we have to explore the models. Whatever we bring in, it’s going to change. Parts of it are going to work and parts of it are not going to work.”

He said we could not just clone a system based on one in another country, but had to create one of our own.

“There’s no such thing as a perfect health service. Every health service has problems.”

Prof Staines said he had colleagues in Dublin who had 8,000 patients in their diabetes clinics. No other country had such a system.

“This is just inefficient. We need to send the money where the care should be delivered.”

Privatisation concern

He said he would personally be very concerned about privatisation of the healthcare system.

“If all else fails, the minister for health can sack the chief executive of a hospital group. He can’t sack the chief executive of the Mater Private,” he said.

But he said the private hospitals provided necessary capacity for the system. “So we have to find a way of bringing them into the tent.”

Prof Staines said much better information systems would be part of the new healthcare system, as would much more effective use of nurses.

He suspected there would be more large-scale practices with many GPs – probably salaried and not partners.

“I do think that is the way forward. That we make much more use of the skills of our nurses who are a remarkably competent group and we use our GPs in a different way.”

Directing resources

Money in the healthcare system also needed to be directed at helping people take care of their illnesses at home and in the community.

Prof Staines said we did not at present have the structures to allow us to work out costs in the healthcare system.

“We are running information systems that would be regarded with contempt by a supermarket branch manager,” he said.

Louise O’Donnell, head of the Impact trade union’s health division, said universal health insurance for a family of four could cost as much as €3,600, making property taxes and water charges look “modest by comparison”.

She said the figure was based on former minister for health James Reilly’s “optimistic” estimate that the basic UHI package would cost €900 per individual.

The biggest burden would fall on families that have no health insurance and no medical card.